IMPLICIT RATIONING CRITERIA IN NON-SMALL-CELL LUNG-CANCER TREATMENT

Data collected from lung cancer patients attending the Victoria Clinic of the British Columbia Cancer Agency are used to investigate how res ources are rationed in the treatment of non-small-cell lung cancer (NS CLC). An ordered legit model is estimated to analyse empirically the r elationship between treatment selection and: tumour stage, size and di fferentiation; the Feinstein index; Karnofsky performance status (KPS) ; and the patient's age, gender and marital and smoking status. Implic it rationing is found to occur with respect to all of these factors ex cept the Feinstein index, gender and marital status. With respect to a ge, KPS and smoker status the main empirical results are: (a) an incre ase in age from 50 to 85 reduces the expected treatment expenditure by 50-70%, depending on the patient's KPS and smoker status; (b) patient s with a KPS less than 80 and of 80, receive 30-46% and 75-85%, respec tively, of the expected treatment expenditure for patients with a KPS of 90 or 100, depending on age and smoker status; (c) the expected tre atment expenditure for active smokers is about 71-86% of the expenditu re for non- or former smokers depending on age and KPS.